Trifluoperazine is a phenothiazine that is used to treat schizophrenia and anxiety. It is not approved for the treatment of dementia-related psychosis as this can increase risk of death.

Trifluoperazine brand names

The most common brand name for trifluoperazine is Stelazine. Other brand names include Eskazinyl, Eskazine, Jatroneural, Modalina, Sizonil, Stilizan, Terfluzine, Trifluoperaz and Triftazin.

What is trifluoperazine prescribed for?

Trifluoperazine is a long-established and high potency antipsychotic drug used in the treatment of schizophrenia and schizophrenia-like illnesses. It has proven very effective for treating ‘positive symptoms’ of schizophrenia, such as hearing voices, seeing objects or people that others do not see, and having strange beliefs. [1] Other positive symptoms of schizophrenia include difficult behaviors such as agitation and aggression. [2]

Trifluoperazine can also be used as a short-term treatment for people with anxiety whose symptoms have not been successfully treated with other drugs. [2]

How does trifluoperazine work?

Trifluoperazine works by calming overactivity in the brain. It does this by causing a post-synaptic D2 dopamine receptor blockade in the brain. [1] Dopamine is a neurotransmitter in the brain that helps regulate mood and behavior, as well as other things. Schizophrenia, and other psychotic illnesses, are thought to be a symptom of overactivity of dopamine in the brain. By blocking the receptors that dopamine binds to, this helps to prevent dopamine overactivity.

In smaller doses, trifluoperazine is used to treat anxiety.

Due to the way it is metabolized, the clinical effects of trifluoperazine can take two to three weeks to appear.

How is trifluoperazine usually taken?

Trifluoperazine is usually taken orally as a tablet. If it is prescribed to treat schizophrenia, the initial dose is 2 to 5 mg twice a day. This is then increased to 15 to 20 mg per day. The maximum dose is 40 mg per day. Never take more than prescribed without medical advice. 

When used to treat anxiety, there is also an initial dose of 1 to 2 mg twice a day. This is then increased to 6 mg per day. When treating anxiety, trifluoperazine should only be used for up to 12 weeks, and no longer than this. The clinical advice is that the lowest dosage should be used for the shortest amount of time. 

It can be taken with or without food. Your doctor will tell you how much you are meant to take. If you forget to take a dose, take it as soon as you remember it, unless it is nearly time for the next dose. In this case, skip the missed dose and continue with the normal dosing schedule.

How long does trifluoperazine stay in your system?

Peak plasma levels of trifluoperazine are reached around 1.5 to 6 hours after ingestion. It has a multiphasic elimination, with an alpha phase elimination half-life of around 3.6 hours. The terminal elimination half-life (time taken for the biological substance to decrease by half in the blood) is 22 hours.

Trifluoperazine side effects

Trifluoperazine has similar effectiveness to other common antipsychotic drugs but may cause more side effects. Therefore, other antipsychotic drugs should be considered before using Trifluoperazine. [1]

You should tell your doctor at the earliest opportunity if any of the following adverse effects are severe or do not go away:

  • Dizziness
  • Loss cof coordination
  • Blurred vision
  • Dry mouth
  • Nausea
  • Blocked nose
  • Urinaryretention
  • Widening or narrowing of pupils
  • Constipation
  • Changes in appetite
  • Weight gain
  • Blank facial expression
  • Shuffling walk
  • Agitation
  • Unusual or uncontrollable movements
  • Difficulty falling or staying asleep
  • Headaches
  • Weakness
  • Extreme tiredness
  • Decreased sexual desire
  • Breast enlargement
  • Breast milk production
  • Missed menstrual periods[2]

Some side effects are serious. You should seek emergency medical attention if you have any of the following symptoms:

  • Fever
  • Confusion
  • Muscle rigidity
  • Falling
  • Chest pain
  • Fast or irregular heartrate
  • Flu-like symptoms
  • Excessive sweating
  • Sore throat, chills, or other signs of infection
  • Yellowing of the eyes or skin
  • Neck cramp
  • Throat pain
  • Tongue that sticks out of the mouth
  • Trouble with breathing or swallowing
  • Uncontrollable, rhythmic face, mouth, or jaw movements
  • Seizures
  • Blisters
  • Skin rashes hives
  • Itches
  • Swelling of the eyes, face, mouth, lips, tongue, throat, arms, hands, feet, ankles, or lower legs
  • Long-lasting erection
  • Loss of vision, especially in low light [2]

Trifluoperazine precautions

If you are known to be allergic to phenothiazines, such as chlorpromazine, fluphenazine, perphenazine, prochlorperazine, promethazine, or thioridazine (or any other medication) you should tell your doctor or pharmacist before taking trifluoperazine, as serious allergic reactions can occur. 

You should also inform your doctor if you are taking any other prescription or non-prescription medications including (but not limited to) vitamins, herbs, nutritional supplements, blood thinners (such as warfarin), antihistamines, barbiturates (such as pentobarbital), anti-anxiety medication or medicines for mental illness or seizures. 

You must also tell your doctor if you have ever had liver disease or any condition that affects the production of blood cells by bone marrow. [2]

Inform your doctor of any previous medical condition, as it can affect how you react to this medication.

If you are pregnant, plan to become pregnant or are breast-feeding, please tell your doctor. Trifluoperazine can cause problems in newborn babies if it is taken in the last months of pregnancy. [2] 

If you have surgery, including dental work, whilst on trifluoperazine, please inform the doctor or dentist.

If you are having an x-ray taken of your spine (myelogram), tell your doctor and radiographer that you are taking trifluoperazine beforehand. They will likely tell you to adjust your doses before the x-ray. 

Do not operate heavy machinery or drive until you know how this medication affects you as it can make you drowsy and affect your movements.

It is generally advisable to avoid alcohol whilst taking trifluoperazine as alcohol can make the symptoms worse. 

Trifluoperazine can make you more sensitive to sunlight, so wear protective clothing and sunblock if you are in direct sunlight. 

Trifluoperazine can make it harder for your body to cool down. Talk to your doctor if you plan on doing vigorous exercise whilst taking trifluoperazine. 

People who handle trifluoperazine tablets have a small chance of developing skin rashes. If anyone helps you take the medication, they should avoid direct contact with the tablets.

Trifluoperazine interactions

If you are taking antipsychotics, appetite suppressants such as sibutramine, malaria drugs such as halofantrine, or phenothiazines such as metrizamide or pimozide, you should avoid taking trifluoperazine as they can interact severely together. 

Other interactions to be aware of are anticoagulants like warfarin, as these can prevent trifluoperazine from working effectively. [3]

As mentioned, you should inform your doctor if you are taking any other medication before taking trifluoperazine.

Trifluoperazine storage

This medication should be kept in a child-proof, tightly closed container and kept out of the reach of children. It should be stored at room temperature and away from moisture and excess heat (so not in the bathroom).

What to do if you overdose on trifluoperazine

If you have any of the following symptoms, call the poison control helpline (1-800-222-1222):

  • Sleepiness
  • Loss of consciousness
  • Unusual movements of the body
  • Agitation
  • Restlessness
  • Fever
  • Seizures
  • Dry mouth
  • Irregular heartbeat 

If the victim has collapsed, has trouble breathing or cannot be awakened, you should immediately call the emergency services on 911.

Resources:

  1. Koch K, Mansi K, Haynes E, Adams CE, Sampson S, Furtado VA. Trifluoperazine versus placebo for schizophrenia. Cochrane Database Syst Rev. 2014 Jan 11;2014(1):CD010226. doi: 10.1002/14651858.CD010226.pub2. PMID: 24414883; PMCID: PMC6718209.
  2. AHFS Patient Medication Information [Internet]. Bethesda (MD): American Society of Health-System Pharmacists, Inc.; c2019. Trifluoperazine; [updated 2017 Jul 07; reviewed & cited on 2022 Nov 04]. Available from: https://medlineplus.gov/druginfo/meds/a682121.html
  3. Raghav D, Mahanty S, Rathinasamy K. Characterizing the interactions of the antipsychotic drug trifluoperazine with bovine serum albumin: Probing the drug-protein and drug-drug interactions using multi-spectroscopic approaches. Spectrochim Acta A Mol Biomol Spectrosc. 2020 Feb 5;226:117584. doi: 10.1016/j.saa.2019.117584. Epub 2019 Oct 12. PMID: 31698317.